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Clinical Nutrition > Nutritional assessment > Flashcards

Nutritional assessment Flashcards

1
Q

Albumin

A

35-50 g/L

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2
Q

Hb

A

< 120 g/L

<140 g/L

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3
Q

hematocrit (%)

A

< 37 % women, 40% men

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4
Q

glucose

A

3.9-6.1 mmol/L ( ~4-7mmol/L)

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5
Q

Nitrogen balance equation

A

( protein intake g / 6.25 ) - ( UUN +4 )

UUN in mmol= (UUN) x volume (L)

UNNmmol x ( 0.028g )

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6
Q

BMI

A

kg/ m^2

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7
Q

normal BMI

A

18.5 - 25

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8
Q

% weight change

A

( UBW- current)/ UBW x 100

  • at risk if >5% in 1 mo, >10 % in 6 mo
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9
Q

to assess somatic protein levels?

A

N balance, creatine levels

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10
Q

4 major visceral proteins

A

albumin ( 17-21 days), transferritin ( 8-10 days), pre-albumin (2-4 days), RBP ( 10-12 hours)

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11
Q

albumin may be increased due to

A

dehydration ( diarrhea, vommiting )

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12
Q

albumin may be lowered not just due to inadequate protein but also

A

neg-acute protein, trauma, liver damage, over hydration, Mal- absorption, aging, edema

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13
Q

when would RBP and TTR be elevated? why?

A

renal disease, bc they are filtered and metabolized in the kidney

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14
Q

TTR also high in

A

hodgkins disease

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15
Q

RBP lowered also during?

A

liver disease, vit A def, zinc def, hyperthyroidism ( same as TTR)

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16
Q

transferrin high during

A

pregnancy, iron def

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17
Q

order of depletion for iron status

A

iron stores, transport iron, essential iron

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18
Q

lab tests for anemia

A

Hb
- if low further tests
serum ferritin ( would be low with low stores)
serum iron ( would also be low with deficiency )
total iron-binding capacity ( TIBC) –> need this to calculate transferrin saturation. if this is high it is indicative of iron def
transferrin saturation: would be lowered ( < 30% def)
erythrocyte protoporphyrin: severe iron def, protoporphyrin will replace Hb, so this would increase in late stages of iron def

  • main markers are the first 3 ( hb, ferritin, TIBC)
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19
Q

waist circumference

A

if >120 W, >140 M, increased risk of CVD and diabetes independent of BMI

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20
Q

lab tests fro folate deficiency anemia

A

serum folate - to detect first

RBC folate - would indicate more severe folate def

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21
Q

why is Hb not a good indicator of iron deficiency?

A

as shown in the graphs, it’s decline is not seen until after Fe depletion. In comparison, ferritin stores decline earlier on and before depletion occurs. in this sense, if one measured serum ferritin - iron def could be caught much earlier

22
Q

risk factors for poor iron status

A 
vegetarian 
low vitamin C
low fortified foods
fequent teas and coffee with meals 
iron inhibitors with meals ( phytates, tannins, oxalates- plant anti-nutrients - beans, grains, nuts, seeds)
ASA use
menorrhagia
3 + annual blood donations
pregnancy
23
Q

iron supplementation should be what?

A

ferrous sulfate
- ferrous = 3x better absorption
rise 1 g/L of Hb per week
- take on empty stomach with liquid

24
Q

Clinical assessment

A

patients medical, social, psychological history

- physical examination for clinical signs of symptoms

25
Q

TEE includes

A

REE or BMR (65-70%)
PA (20-30%)
TEF (10%)

injury/stress

26
Q

TEE = ?

A

REE x Activity factor x stress factor

or institute of medicine equations:

women: TEE= 387 - (7.31 x age) + PA x (10.9 x weight (kg) + 660.7 x height (m))

27
Q

Harris - Benedict (1919) limitations

A
  • tends to overestimate by 5-15%

- can’t use in obese indiviuals

28
Q

when do we use ideal weight?

A

if patient is obese > 30 BMI and non-hospitalized

- except for Mifflin- St jeor

29
Q

to find TEE first must find?

A

REE with an estimate of one of the 4 main equations, or indirect calorimeter

30
Q

in Mifflin- st Joer equation what is important?

A

to always use current body weight

- better predicts REE in non- obese and obese subjects

31
Q

REE is used interchangeably to?

A

BMR, BEE ( for purées of this course)

32
Q

REE is directly proportional to ??

A

lean body mass

- in Harris- Benedict equation this is based on the fact that men have more LBM and with age, LBM decreases

33
Q

which equation is not appropriate for obese patients and tend to overestimate by 5-10%

A

H-B equation

34
Q

FAO/WHO

A

only factors in weight and categorized by age and sex

- tend to be less precise due to simplicity

35
Q

Mifflin-st Jeor

A

less overestimation than H-B

  • in general more appropriate for obese individuals
  • but in extremely obese not as much bc more weight is due to more fat and not more LBM ( however yes, obese ppl have more LBM than thin, but at the extreme side, more fat )
  • important o use CURRENT body weight in this one, even if above 30. ( unless over BMI of 35, than use BMI to 30
  • PAL and stress factor must be included
36
Q

Rule of thumb

A

25-35 kcal/kg body weight for non-obese ppl

37
Q

in Mifflin if patient has BMI of 32 do you use current or ideal BW?

A

current, only if above 35 do change to 30

38
Q

PAL

A

multiply the REE by PAL

- this combines both normal movements and sports/exercise

39
Q

the institute of medicine has what that is different?

A

physical activity factor

- in the previous ones it was PAL but this equation has PA factor

40
Q

in summary of equations

A

we have two options: use equation to estimate REE x by PAL x stress factor OR use IOM equation which incorporates everything ( using a PA instead) and does not have a stress factor ( bc it is for healthy ppl )
- using for hospitalized patients and x-ing by stress factor is actually an overestimate

41
Q

healthy adults protein

A

1.0 g/kg/day

42
Q

elderly adults PRO

A

1.0-1.2 g/kg/day

43
Q

over hydration most severe issue/concern

A

hyponatremia

44
Q

fluid balance

A

urine output + 500mL/day

45
Q

do fluid req change in various states of disease

A

yes

46
Q

list symptoms of dehydration ( not common ones )

A

trachycardia
lowered BT
rapid weight loss (1kg= 470ml)
increase in albumin, Na, creatine, Hb, Hct

47
Q

over hydration symptoms

A 
increased BP
edema
slow pulse
decrease Na, K, Albumin, creatine, Hb, Hct
rapid weight gain
48
Q

things to consider for elderly as bod changes

A 
lowered LBM 
low appetite - reduced energy
need higher protein
decrease Ca absorbance
vit D less effacent synthesis
decrease sense of thirst
49
Q

prevalence of malnutrition

A

15% - community
15-80% - hospitals
80% in long term care

50
Q

tool for screening malnutrition that is canid, reliable, sensitive, specific?

A

doesn’t exist

51
Q

elements of screening?

A

current condition- BMI
stable condition- ( involuntary weight loss?)
will condition deteriorate? - what is food intake
impact of disease on deterioration

52
Q

what is only valid instrument?

A

NRS 2002 - (nutrition screening risk 2002)

Clinical Nutrition (25 decks)

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